=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710935580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENSITIVE HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 N KANSAS AVE
-----------------------------------------------------
City | LIBERAL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67901-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-624-3797
-----------------------------------------------------
Fax | 620-624-2868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 N KANSAS AVE
-----------------------------------------------------
City | LIBERAL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67901-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-624-3797
-----------------------------------------------------
Fax | 620-624-2868
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMIN
-----------------------------------------------------
Name | MRS. CARLA KAY GUSTASON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 620-624-3797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | A088003
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------